Contribution of visceral fat accumulation to the risk factors for atherosclerosis in non-obese Japanese

Relationship between abdominal circumference and the incidence of hyperuricemia in the general Japanese population

In this study, we aimed to separately evaluate the relationship between waist circumference and the incidence of hyperuricemia in men and women in the general Japanese population. We performed a population-based longitudinal study using data from the annual health examination of residents of Iki City, Japan. A total of 5567 participants without hyperuricemia at baseline were included in the analysis. The men and women were placed into groups according to the tertile of waist circumference. The outcome was incident hyperuricemia (uric acid > 416 µmol/L [7.0 mg/dL]). The relationship between waist circumference and the incidence of hyperuricemia was investigated using Cox proportional hazards models. During the follow-up period, hyperuricemia developed in 697 people (551 men and 146 women). The incidence (per 1000 person-years) of hyperuricemia increased with increasing waist circumference in the men (34.9 for tertile 1, 49.9 for tertile 2 and 63.3 for tertile 3; Ptrend < 0.001) and women (5.5 for tertile 1, 6.3 for tertile 2 and 11.9 for tertile 3; Ptrend < 0.001). Significant associations were identified after adjustment for potential confounders (men: Ptrend < 0.001; women: Ptrend = 0.014). In conclusion, both men and women with larger waist circumferences were at higher risks of subsequent hyperuricemia.

Association of visceral and subcutaneous fat with bone mineral density in US adults: a cross-sectional study

The relationship between the accumulation of fat in visceral or subcutaneous tissue and bone mineral density (BMD) remains unclear. Our primary objective in this study was to illuminate this relationship by conducting an investigation on a vast scale, encompassing a nationally representative population in the United States. A weighted multiple linear regression model was established to evaluate the relationship between visceral fat, subcutaneous fat, and BMD. Additionally, the exploration of the potential nonlinear relationship was conducted employing the methodology of smooth curve fitting. In order to determine potential inflection points, a two-stage linear regression model was utilized. A total of 10,455 participants between the ages of 20 and 59 were included in this study. Various weighted multiple linear regression models revealed a negative correlation between lumbar BMD and visceral mass index (VMI) and subcutaneous mass index (SMI). However, the association between VMI and lumbar BMD displayed a U-shaped pattern upon employing the smooth curve fitting, and the inflection point of 0.304 kg/m2was determined using a two-stage linear regression model. Our findings indicated a negative association between subcutaneous fat and BMD. A U-shaped relationship was observed between visceral fat and BMD.

Predictive modeling the probability of suffering from metabolic syndrome using machine learning: A population-based study

Background

There is an increasing trend of Metabolic syndrome (MetS) prevalence, which has been considered as an important contributor for cardiovascular disease (CVD), cancers and diabetes. However, there is often a long asymptomatic phase of MetS, resulting in not diagnosed and intervened so timely as needed. It would be very helpful to explore tools to predict the probability of suffering from MetS in daily life or routinely clinical practice.

Objective

To develop models that predict individuals' probability of suffering from MetS timely with high efficacy in general population.

Methods

The present study enrolled 8964 individuals aged 40-75 years without severe diseases, which was a part of the REACTION study from October 2011 to February 2012. We developed three prediction models for different scenarios in hospital (Model 1, 2) or at home (Model 3) based on LightGBM (LGBM) technique and corresponding logistic regression (LR) models were also constructed for comparison. Model 1 included variables of laboratory tests, lifestyles and anthropometric measurements while model 2 was built with components of MetS excluded based on model 1, and model 3 was constructed with blood biochemical indexes removed based on model 2. Additionally, we also investigated the strength of association between the predictive factors and MetS, as well as that between the predictors and each component of MetS.

Results

In this study, 2714 (30.3%) participants suffer from MetS accordingly. The performances of the LGBM models in predicting the probability of suffering from MetS produced good results and were presented as follows: model 1 had an area under the curve (AUC) value of 0.993 while model 2 indicated an AUC value of 0.885. Model 3 had an AUC value of 0.859, which is close to that of model 2. The AUC values of LR model 1 and 2 for the scenario in hospital and model 3 at home were 0.938, 0.839 and 0.820 respectively, which seemed lower than that of their corresponding machine learning models, respectively. In both LGBM and logistic models, gender, height and resting pulse rate (RPR) were predictors for MetS. Women had higher risk of MetS than men (OR 8.84, CI: 6.70-11.66), and each 1-cm increase in height indicated 3.8% higher risk of suffering from MetS in people over 58 years, whereas each 1- Beat Per Minute (bpm) increase in RPR showed 1.0% higher risk in individuals younger than 62 years.

Conclusion

The present study showed that the prediction models developed by machine learning demonstrated effective in evaluating the probability of suffering from MetS, and presented prominent predicting efficacies and accuracies. Additionally, we found that women showed a higher risk of MetS than men, and height in individuals over 58 years was important factor in predicting the probability of suffering from MetS while RPR was of vital importance in people aged 40-62 years.

Prevalence of Prehypertension and Associated Cardiovascular Risk Profiles among Adults in Peru: Findings from a Nationwide Population-Based Study

Prehypertension is a clinical condition that increases the risk of hypertension and cardiovascular disease. In South American countries, prehypertension affects almost one-third of the population. The aim of the present study was to determine the association between prehypertension and the main cardiometabolic risk factors according to the US National Cholesterol Education Program Adult Treatment Panel III by sex in the Peruvian population. A total of 863 participants surveyed were included in the study. A total of 21.1% had prehypertension, 14.4% of whom were female, and 30.5% were male. Women belonging to the age group 50–59 years, having abdominal obesity and being a current smoker, were more likely to have prehypertension, while the likelihood of having prehypertension increased in men with abdominal obesity. Three out of 10 men and one out of 10 women in Peru have prehypertension. In women, being 50 to 59 years of age, having abdominal obesity, and being a current smoker, increased the probability of having prehypertension, whereas, in men, only abdominal obesity was found to be associated with prehypertension. Our findings will allow the development of prevention strategies focused on the appropriate diagnosis of prehypertension and cardiometabolic risk factors according to sex.

Visceral Fat Area by Abdominal Bioelectrical Impedance Analysis as a Risk of Obstructive Sleep Apnea

This is the first study to evaluate directly visceral fat area (VFA) using a visceral fat (VF) meter by the abdominal bioelectrical impedance analysis (A-BIA) method in obstructive sleep apnea (OSA) patients diagnosed with polysomnography (PSG). The purpose of this study is to clarify (1) whether VFA measurement using a VF meter by the A-BIA method is possible even in a private clinic without burdening patients and staff and (2) how much VFA affects OSA compared to body mass index (BMI). Even without a computed tomography scan, which is the gold standard for VFA measurement, a VF meter could analyze patients by the A-BIA method and easily measure VFA. Therefore, it could be used safely even in a private sleep clinic, with very little burden on the patients and the medical staff. We investigated the association between OSA and VFA in 133 OSA patients. Multiple regression analysis revealed that VFA (β = 0.28; P = 0.020) was a stronger coexisting factor for OSA than age, male gender, or BMI (β = 0.26; P = 0.032) in all OSA patients. In the OSA patients with VF accumulation, only VFA was a significant component of OSA severity (β = 0.36; P = 0.006). The A-BIA method instrument could become a useful device for the evaluation of VF accumulation in OSA patients in private sleep clinics. VF accumulation should be recognized as an important risk factor as well as a known risk factor for OSA.

The reduction impact of monoglucosyl rutin on abdominal visceral fat: A randomized, placebo-controlled, double-blind, parallel-group

Water soluble α-glycosylated rutin (4G-α-D-glucopyranosyl rutin, monoglucosyl rutin, MR) was used in this study to evaluate its ability to reduce abdominal visceral fat (AVF). We conducted a study examining 66 healthy Japanese men and women with a body mass index of ≥23 and <30 kg/m²  for 8 weeks. The subjects were randomly assigned to groups via computer random numbers as follows: MR200 group (MR 200 mg/day), MR400 group (MR 400mg/day), or placebo group. The primary outcome was change in the AVF area after 8 weeks of intervention. The secondary outcomes were effects of MR on total fat and subcutaneous fat of umbilical area, lipid-related markers, and subjective symptoms. The per-protocol set analysis involved 18 subjects in the placebo group (7 males and 11 females), 20 subjects in the MR200 group (8 males and 12 females), and 20 subjects in the MR400 group (8 males and 12 females). AVF area in both the MR200 and MR400 groups was reduced at week 8, with changes from the baseline (week 0) significantly higher than the placebo group. Additionally, the MR400 group reported improved subjective symptoms concerning being "worried about abdominal fat" at week 4 compared with the placebo group. These results indicate that the consumption of MR (200 and 400 mg/day) for 8 weeks reduced AVF. PRACTICAL APPLICATION: Monoglucosyl rutin, an enzymatically modified form of rutin, is a highly stable and water-soluble flavonoid widely used in food and beverages to prevent oxidation. The present clinical study demonstrated that it may improve overall health by reducing abdominal visceral fat.

Characteristics of sarcopenia after distal gastrectomy in elderly patients

Presence of preoperative sarcopenia is a risk factor for postoperative complications. However, there are few reports on the presence of sarcopenia and its characteristics following gastrectomy. Sarcopenia is closely related to quality of life in elderly people. To date, the main purpose of follow-up after gastrectomy is surveillance for early detection of recurrence and secondary cancer. However, henceforth, quality of life in elderly gastric cancer patients after gastrectomy must also be evaluated. The present study aimed to investigate sarcopenia during a 1-year postoperative course in elderly gastric cancer patients and examine their characteristics. The subjects were 50 patients aged ≥70 years who underwent laparoscopy-assisted distal gastrectomy for gastric cancer and who experienced no recurrence 1 year postoperatively. Height, weight, serum albumin levels, food intake amount, grip strength, gait speed, visceral fat area, and appendicular skeletal muscle mass index were measured preoperatively and 6 months and 1 year postoperatively. Sarcopenia, obesity, and visceral obesity were diagnosed. Compared with preoperatively, indicators other than height decreased 6 months postoperatively. Compared with 6 months postoperatively, body weight, amount of food intake, and visceral fat area increased by 1 year postoperatively, unlike appendicular skeletal muscle mass index. The frequency of sarcopenia increased 6 months postoperatively compared with preoperatively; this frequency remained almost unchanged 1 year postoperatively compared with 6 months postoperatively. Further, the frequency of visceral obesity increased 1 year postoperatively compared with 6 months postoperatively. Weight increased after > 6 months postoperatively; however, most of the weight increase was in terms of fat and not muscle. We emphasize the importance of considering postoperative sarcopenia and visceral obesity. In particular, sarcopenia and visceral obesity should be carefully monitored after increases in body mass index and food consumption.

Anthropometric Obesity Indices were Stronger than CT-Based Indices in Associations with Carotid Intima-Media Thickness in Japanese Men

AIM

Computed tomography (CT) can directly provide information on body compositions and distributions, compared to anthropometric indices. It has been shown that various obesity indices are associated with carotid intima-media thickness (IMT). However, whether CT-based obesity indices are stronger than anthropometric indices in association with atherosclerosis remains to be determined in a general population.

METHODS

We cross-sectionally assessed carotid IMT using ultrasound in 944 community-dwelling Japanese men free of stroke and myocardial infarction. CT image at the L4-L5 level was obtained to compute areas of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Anthropometric measures assessed included body mass index (BMI), waist circumference, and waist-to-hip ratio. Using multivariable linear regression, slopes of IMT per 20^th to 80^th percentile of each index were compared. We also compared the slope of index with simultaneous adjustment for BMI in the same model.

RESULTS

Areas of VAT and SAT were positively associated with IMT, but not stronger than those of anthropometric indices in point estimates. Among all obesity indices, BMI was strongest in association with IMT after adjusting for age and lifestyle factors or further adjusting for metabolic factors. In simultaneous adjustment models, BMI, but not CT-based indices, remained significant and showed the strongest association.

CONCLUSIONS

In community-dwelling Japanese men, anthropometric obesity indices, BMI in particular, were more strongly associated with carotid atherosclerosis than CT-based obesity indices. The association of general obesity with carotid atherosclerosis was strong and adding CT-based obesity measure did not considerably influence in the association.

The importance of waist circumference and body mass index in cross-sectional relationships with risk of cardiovascular disease in Vietnam

BACKGROUND

Waist circumference (WC) is an indicator of intra-abdominal adipose tissue, high levels of which confer an increased risk of cardiometabolic disease. Population data on WC should be more informative than data on body mass index (BMI), which is a general indicator of body size. This study aimed to evaluate the importance of WC relative to BMI in cross-sectional relationships with blood pressure (BP), glucose, and total cholesterol (TC) in the adult population of Vietnam.

METHODS

The data were collected in a population-based survey conducted during 2009-10 using the "WHO STEPwise approach to surveillance of risk factors for non-communicable disease" (STEPS) methodology. The survey participants (n = 14 706 aged 25 to 64 years) were selected by multi-stage stratified cluster sampling from eight provinces representative of the eight geographical regions of Vietnam. All measurements were performed in accordance with the STEPS protocols. All analyses were performed using complex survey methods.

RESULTS

The measurements of WC and BMI were highly correlated (men r = 0.80, women r = 0.77). For men, the strongest and predominant associations with BP, glucose, and TC were for WC or an index based on WC. For women, this was true for glucose but BMI was more important for BP and TC. WC or an index based on WC provided better discrimination than BMI of hypertension and elevated glucose, and of raised TC for men. Information on four new anthropometric indices did not improve model fit or subject discrimination.

CONCLUSION

For BP/hypertension, glucose/elevated glucose, and TC/raised TC, WC was more informative than BMI for Vietnamese men, but both WC and BMI were important for Vietnamese women. Both WC and BMI need to be assessed for estimation of CVD risk in Vietnam.

Effects of monthly feedback of VFA measured by dual BIA method in Japanese patients with obesity: a randomized controlled study

Objective

To investigate the effects of monthly feedback of changes in visceral fat area (VFA) as measured by dual bioelectrical impedance analysis method and the importance of VFA in individuals with obesity.

Methods

Thirty‐eight Japanese patients with obesity underwent VFA measurements. The feedback group was given feedback on VFA measurements each month for 4 months. The control group underwent VFA measurements at the beginning and end of the study but was not informed of the results. All the study participants completed eating behaviour and weight efficacy lifestyle questionnaires.

Results

Mean age was 53.9 (14.3) years; mean body mass index was 30.6 (4.3) kg m⁻². At the 4‐month follow‐up, there was no significant difference in VFA reduction between the control and feedback groups (−4.4% vs. −3.0%; 95% CI, −3.8 to 5.5). In post‐hoc analysis using the overall group irrespective of allocation, changes of eating style were significantly associated with a reduction in VFA at 4 months (p = 0.034).

Conclusions

Monthly feedback on changes in VFA does not reduce VFA. More frequent feedback may be required. In post‐hoc analysis, changes of eating style were associated with a reduction in VFA.

Cholesterol levels of Japanese dyslipidaemic patients with various comorbidities: BioBank Japan

BACKGROUND

Controlling serum cholesterol is critical to prevent cardiovascular disease in patients with dyslipidaemia. Guidelines emphasise the need to select treatment for dyslipidaemia based on specific patient profiles; however, there is little information about the serum cholesterol levels of patients in each profile in Japan. Therefore, we aimed to describe the serum cholesterol levels and prevalence of uncontrolled cases in Japanese patients with dyslipidaemia.

METHODS

We included data for patients with dyslipidaemia between 2003 and 2007 from the BioBank Japan Project (66 hospitals). Then, we reported their serum cholesterol levels by age, body mass index, glycaemic control (glycated haemoglobin A1c), blood pressure, smoking, drinking, comorbidity and medication profiles.

RESULTS

We included 22,189 male and 21,545 female patients. The mean serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG) and non-HDL-C levels in males were 117.4 mg/dL, 51.0 mg/dL, 187.6 mg/dL and 153.6 mg/dL, respectively; the corresponding levels in females were 129.5 mg/dL, 60.5 mg/dL, 144.9 mg/dL and 157.9 mg/dL, respectively. In both males and females, the LDL-C levels were the highest in the following profiles: age 19-44 years, body mass index 18.5-22 kg/m², glycated haemoglobin A1c <6.0%, never smoker, chronic respiratory disease as a comorbidity and no medication use.

CONCLUSIONS

These data provide details of serum cholesterol levels by risk-factor profile in patients with dyslipidaemia and could add evidence of treatment decisions.

Waist circumference and waist-to-height ratio are associated with periodontal pocketing-results of the Health 2000 Survey

Background

Body mass index (BMI) has been found to associate with different parameters of chronic periodontal disease in previous studies. It is reasonable to expect that central adiposity measures, such as waist circumference and waist-to-height ratio, which indirectly takes into account visceral fat, are more accurate measures of obesity-related oral health risks than BMI. The aim of this study was to examine whether central obesity is associated with periodontal pocketing, an indication of infectious chronic periodontal disease.

Methods

The study was based on a subpopulation from the national Health 2000 Survey in Finland. It included dentate, non-diabetic, never-smoking subjects aged 30–49 (n = 1287). The outcome variable was the number of teeth with deepened periodontal pockets (4 mm or more) and the number of teeth with deep periodontal pockets (6 mm or more). Central obesity was measured by means of waist circumference (WC) and waist-to-height ratio (WHtR). Poisson regression models were used to estimate prevalence rate ratios (PRR) and their 95% confidence intervals.

Results

Our main finding was that both WC and WHtR were associated with the number of teeth with deeper (4 mm or more) periodontal pockets; the PRR for the fifth quintile in WC was 1.5, CI: 1.2–1.9 and in WHtR 1.4, CI: 1.1–1.7, when compared to the lowest quintile. Corresponding figures for deep (6 mm or more) periodontal pockets were 2.3, CI: 0.9–6.1 for WC and 1.9, CI: 0.8–4.4 for WHtR. There were no essential differences in the strengths of the associations between WC and WHtR and the number of teeth with deepened periodontal pockets.

Conclusion

Both central adipose measures—WC and WHtR—seem to be associated with periodontal pocketing in non-diabetic, never-smoking subjects aged 30–49 years old.

Risk for metabolic diseases in normal weight individuals with visceral fat accumulation: a cross-sectional study in Japan

OBJECTIVE

To investigate the association between visceral fat area (VFA) and metabolic syndrome (Mets) among normal weight Japanese.

DESIGN

A cross-sectional study.

SETTING

The health check-up centre of the Takeda Hospital group in Kyoto, Japan.

METHODS

This study involved 1674 men and 1448 women aged 30-74 years who underwent medical check-ups in 2012 in the health check-up centre. They were stratified by Body Mass Index (BMI cut-off for obesity is set at 23.0 kg/m² for Asians): normal weight 18.5-22.9 kg/m² or higher weight ≥23.0 kg/m². The age-adjusted ORs of the 2nd to 4th groups of sex-specific VFA quartiles compared with the 1st quartile for a Mets component clustering were estimated. The clustering was having two or more of the following factors: high blood pressure, high fasting blood glucose (FBG), low high-density lipoprotein cholesterol (HDL-C) and high triglycerides. Statistical analyses were conducted in 2016.

RESULTS

Participants in the 2nd to 4th VFA quartiles had significantly higher clustering risks; ORs were 3.4 (1.5 to 8.0), 6.3 (2.8 to 14.2) and 9.3 (4.2 to 20.7) for normal weight participants, and 1.7 (1.2 to 2.6), 2.6 (1.8 to 3.9) and 6.0 (4.1 to 8.8) for higher weight participants, respectively. The ORs of the 4th VFA quartile for Mets components were significantly higher; ORs for normal weight participants were 2.1 (1.5 to 3.0) (high blood pressure), 2.4 (1.4 to 4.2) (high FBG), 5.2 (2.1 to 12.9) (low HDL-C) and 12.0 (5.7 to 25.3) (high triglycerides), and higher weight participants were 3.9 (2.8 to 5.5), 4.1 (2.8 to 6.2), 3.9 (2.2 to 6.9) and 5.0 (3.4 to 7.4), respectively.

CONCLUSIONS

Among participants with normal weight, as well as those of higher weight, dose-dependent responses were observed between VFA and risk for Mets components and the clustering among Japanese adults. VFA may be useful information for interventions to improve metabolic risk factors in people with normal weight.

The Associations Between Smoking Habits and Serum Triglyceride or Hemoglobin A1c Levels Differ According to Visceral Fat Accumulation

BACKGROUND

Whether smokers and former smokers have worse lipid profiles or glucose levels than non-smokers remains unclear.

METHODS

The subjects were 1152 Japanese males aged 42 to 81 years. The subjects were divided according to their smoking habits (nonsmokers, former smokers, and current smokers) and their visceral fat area (VFA) (<100 cm(2) and ≥100 cm(2)).

RESULTS

The serum triglyceride (TG) levels of 835 males were assessed. In the VFA ≥100 cm(2) group, a significantly greater proportion of current smokers (47.3%) exhibited TG levels of ≥150 mg/dL compared with former smokers (36.4%) and non-smokers (18.8%). The difference in TG level distribution between former smokers and non-smokers was also significant. However, among the subjects with VFA of <100 cm(2), the TG levels of the three smoking habit groups did not differ. The serum hemoglobin A1c (HbA1c) levels of 877 males were also assessed. In the VFA <100 cm(2) group, significantly higher proportions of current smokers (17.9%) and former smokers (14.9%) demonstrated HbA1c levels of ≥5.6% compared with non-smokers (6.3%). In contrast, in the VFA ≥100 cm(2) group, significantly fewer former smokers displayed HbA1c levels of ≥5.6% compared with non-smokers and current smokers. Furthermore, the interaction between smoking habits and VFA was associated with the subjects' TG and HbA1c concentrations, and the associations of TG and HbA1c concentrations and smoking habits varied according to VFA.

CONCLUSIONS

Both smoking habits and VFA exhibited associations with TG and HbA1c concentrations. The associations between smoking habits and these parameters differed according to VFA.

Association of decrease in carbohydrate intake with reduction in abdominal fat during 3-month moderate low-carbohydrate diet among non-obese Japanese patients with type 2 diabetes

OBJECTIVE

The effectiveness of a moderate low-carbohydrate diet (M-LCD) has been demonstrated in terms of glycemic control, body weight and serum lipid profiles. We investigated the effect of a 3-month M-LCD on visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and examined an association between decrease in carbohydrate intake and reduction in abdominal fat among patients with Type 2 diabetes mellitus (T2DM).

METHODS

Seventy-six patients (45 men and 31 women; mean age ± SD: 59.5 ± 11.1 years) with T2DM were instructed to follow an M-LCD for 3 months. We assessed abdominal fat distribution using computed tomography and macronutrient intakes from 3-day dietary records at baseline and after 3 months.

RESULTS

The patients complied well with the M-LCD - %carbohydrate: %fat: %protein at baseline and after 3 months were 51:27:15 and 41:33:18 in men and 54:27:16 and 42:37:19 in women, respectively. VAT and SAT significantly decreased during the 3 months (P for time < 0.001 for both). Decrease in carbohydrate intake (g/day) and %carbohydrate were correlated with decrease (%) in VAT. The correlations were significant in men (Spearman correlation coefficient r = 0.469 for carbohydrate intake (g) and r = 0.402 for %carbohydrate) but not in women (r = 0.269 and 0.278, respectively). The correlations in men remained significant in multiple regression analysis adjusted for age and changes in energy intake.

CONCLUSIONS

In men, decrease in carbohydrate intake was significantly correlated with VAT loss during a 3-month M-LCD, independently of reduction in energy intake.

Association of dietary factors with abdominal subcutaneous and visceral adiposity in Japanese men

OBJECTIVE

The aim of this study was to assess the relationship between dietary factors and abdominal subcutaneous and visceral adipose tissue in overweight and obese men.

METHODS

A pooled cross-sectional analysis was conducted to evaluate the associations between dietary factors (nutrition, dietary pattern and alcohol consumption) and subcutaneous fat area (SFA) and visceral fat area (VFA) in 301 Japanese men, aged 21-65 years.

RESULTS

The standardized regression coefficients of major dietary items (total energy intake, energy intake from breakfast, lunch, supper, between-meal, protein, fat, carbohydrate and alcohol) were positive for VFA in multiple linear regression analyses with the use of age and dietary items as independent variables. The energy intake from between-meal snacks correlated with SFA (standardized regression coefficient β = 0.174, p = 0.002). The coefficient of alcohol intake was positive for VFA and negative for SFA, and alcohol intake correlated with the VFA/total fat area (TFA) ratio (β = 0.130, p = 0.009). Alcohol intake was positively correlated with the blood non-esterified fatty acid concentration. Alcohol consumption additively increased energy intake from supper. The risk of an increase to VFA ≥ 100 cm(2) was 2.02 times higher (95% CI: 1.15, 3.56) for subjects whose energy intake was ≥ 2200 kcal/d, and 2.07 times higher (95% CI: 1.26, 3.42) in those who consumed ≥ 3 g/d alcohol. The risk of an increase to a VFA/TFA ratio ≥ 0.4 was 1.81 times higher (95% CI: 1.01, 3.23) for subjects whose energy intake from supper was ≥ 1000 kcal/d.

CONCLUSION

Our results indicate that habitual alcohol drinking and high-energy intake from supper are associated with disproportionate accumulation of visceral fat.

Resting heart rate predicts metabolic syndrome in apparently healthy non-obese Japanese men

Autonomic nervous dysfunction is considered to be one of the mechanisms of metabolic syndrome (MetS). The aim of this study is to investigate whether resting heart rate, a marker of autonomic nervous dysfunction, is a predictor of MetS in apparently healthy non-obese [body mass index (BMI) <25 kg/m(2)] Japanese men. This is an observational study through 3 years in apparently healthy Japanese 1,265 men and 793 women without MetS and with no history of cardiovascular disease and no use of antihypertensive, antidiabetic, or antihyperlipidemic medication at baseline. Hazard ratios (HRs) of incident MetS were calculated for each 1 SD increase in heart rate stratified by gender and obesity. Incidence of MetS for each tertile of heart rate and HRs of MetS for the highest tertile (T3) compared with the lowest tertile (T1) were calculated stratified by gender and obesity. The HRs [95% confidence intervals (CIs)] of MetS for each 1 SD increase in heart rate were 1.319 (1.035-1.681) (p = 0.025) in non-obese men, 1.172 (0.825-1.665) (p = 0.377) in obese men, 1.115 (0.773-1.608) (p = 0.560) in non-obese women, and 1.401 (0.944-2.078) (p = 0.094) in obese women adjusted for BMI, age, smoking, alcohol drinking, and physical activity. The HRs (95% CIs) of MetS for T3 were 2.138 (1.071-4.269) (p = 0.031) in non-obese men and 1.341 (0.565-3.180) (p = 0.506) in obese men adjusted for pre-existing five components of MetS, age, smoking, alcohol drinking, and physical activity. In conclusion, an increase in resting heart rate was a significant predictor of MetS in non-obese Japanese men.

The utility of dual bioelectrical impedance analysis in detecting intra-abdominal fat area in obese patients during weight reduction therapy in comparison with waist circumference and abdominal CT

An increase in intra-abdominal fat area (IAFA) is an essential component of metabolic syndrome (MetS). Waist circumference (WC) is not a precise measure of IAFA, and computed tomography (CT) is unsuitable for frequent monitoring. Here, we examined utility of a dual bioelectrical impedance analysis (Dual BIA) for measuring IAFA in obese patients during weight reduction. Fat distribution was measured by Dual BIA and CT in 100 obese outpatients. All fat areas including total, IAFA, and subcutaneous fat by Dual BIA were more closely correlated with those by CT than WC. Estimated IAFA by Dual BIA was significantly correlated with number of MetS components as well as CT, but WC was not. Furthermore, in 61 obese patients who received 6-month weight reduction therapy, estimated IAFA by Dual BIA showed an earlier and greater decrease as well as that by CT than WC and BMI. In addition, decrease in estimated IAFA by Dual BIA through weight reduction had a higher correlation with decrease in IAFA by CT, than WC. This study is the first to demonstrate that the change in estimated IAFA by Dual BIA was highly correlated with that in IAFA by CT during weight reduction therapy. Our findings also indicate that estimated IAFA by Dual BIA is, potentially, a better indicator of severity of MetS, cardiovascular risk factors, and effectiveness of weight reduction than WC, and equal to IAFA by CT. Estimated IAFA by Dual BIA may be useful for monitoring the effectiveness of weight reduction therapy in obese patients.

Reduction of atherogenic risk in patients with type 2 diabetes by curcuminoid extract: a randomized controlled trial

Curcumin is a phytocompound found in the root of turmeric, a common herbal ingredient in many Asian cuisines. The compound contains anti-inflammatory activity, which is mediated through an up-regulation of adiponectin and reduction of leptin. Consumption of curcumin was shown to prevent some deteriorative conditions caused by inflammation, such as ulcerative colitis, rheumatoid arthritis and esophagitis, and so on. Inflammation-associated cardiovascular conditions such as atherosclerosis are common in diabetes patients. The anti-inflammation effect of curcumin might be beneficial to prevent such condition in these patients. We aim to evaluate an antiatherosclerosis effect of curcumin in diabetes patients. Effects of curcumin on risk factors for atherosclerosis were investigated in a 6-month randomized, double-blinded and placebo-controlled clinical trial that included subjects diagnosed with type 2 diabetes. An atherosclerosis parameter, the pulse wave velocity, and other metabolic parameters in patients treated with placebo and curcumin were compared. Our results showed that curcumin intervention significantly reduced pulse wave velocity, increased level of serum adiponectin and decreased level of leptin. These results are associated with reduced levels of homeostasis model assessment-insulin resistance, triglyceride, uric acid, visceral fat and total body fat. In summary, a 6-month curcumin intervention in type 2 diabetic population lowered the atherogenic risks. In addition, the extract helped to improve relevant metabolic profiles in this high-risk population.

Effect of longitudinal changes in visceral fat area on incidence of metabolic risk factors: the Hitachi health study

OBJECTIVE

To examine the incidences of metabolic risk factors according to changes in visceral fat area (VFA) in a large Japanese population.

DESIGN AND METHODS

The subjects were 973 men who received a computed tomography (CT) examination in health checkups twice (2004-2005 and 2007-2008), and not having two or more of metabolic risk factors (except for the waist circumference) in 2004-2005. VFA was measured using CT. To assess the potential influence of changes in VFA for the 3-year incidences of each metabolic risk factor and clustering metabolic risk factors, logistic regression analyses were used.

RESULTS

A significant association was observed between the change in VFA and the components of the metabolic risk factors. Incidences of the components of the metabolic risk factors were significantly higher among subjects with a larger increase in VFA and were significantly lower among subjects with a larger decrease in VFA (trend P < 0.001). Significant increases in the odds ratios for the incidences of high triglycerides and low high-density lipoprotein cholesterol level were observed among subjects with ≥50 cm(2) VFA increase.

CONCLUSIONS

The adoption of a lifestyle that does not increase the VFA is important for preventing metabolic syndrome.

Early changes of abdominal adiposity detected with weekly dual bioelectrical impedance analysis during calorie restriction

OBJECTIVE

To elucidate early change of intra-abdominal fat in response to calorie restriction in patients with obesity by weekly evaluation using a dual bioelectrical impedance analysis (Dual BIA) instrument.

METHODS

For 67 Japanese patients with obesity, diabetes, or metabolic syndrome, intra-abdominal fat area (IAFA), initially with both Dual BIA and computed tomography (CT), and in subsequent weeks of calorie restriction, with Dual BIA were measured.

RESULTS

IAFA by Dual BIA (Dual BIA-IAFA) correlated well with IAFA by CT (CT-IAFA) in obese patients (r = 0.821, P < .0001, n = 67). Ten males and 9 females (age 49.0 ± 14.4 years, BMI 33.2 ± 7.3 kg/m2) lost more than 5% of baseline body weight (BW) in 3 weeks, and their Dual BIA-IAFA, BW, and WC decreased by 18.9%, 5.3%, and 3.8%, respectively (P < .05, ANCOVA).

CONCLUSION

Dual BIA instrument could detect the weekly change of Dual BIA-IAFA under calorie restriction in obese patients and demonstrated a substantially larger change of IAFA compared with changes of BW and WC in early weeks. This observation corroborates the significance of evaluating IAFA as a biomarker for obesity, and indicates the clinical usefulness of the Dual BIA instrument.

Prevalence of abdominal obesity in Abia State, Nigeria: results of a population-based house-to-house survey

BACKGROUND AND OBJECTIVE

Abdominal obesity is associated with the risk of developing disorders, such as diabetes and hypertension. The objective of this study was to investigate the prevalence of abdominal obesity in Abia State, Nigeria.

MATERIALS AND METHODS

We carried out a cross-sectional study aimed at ascertaining the prevalence of abdominal obesity in Abia State, Nigeria. Participants in the study were recruited from communities in the three senatorial zones in the state. Screening for abdominal obesity was carried out in these subjects using waist circumference (the National Cholesterol Education Program Third Adult Treatment Panel criteria were used). The World Health Organization Stepwise Approach to Surveillance of chronic disease risk factors was used. Body mass index, anthropometric measurements, and other relevant data were also collected.

RESULTS

Data on waist circumference were obtained from 2,807 subjects. The prevalence of obesity using body mass index in the population was 11.12%. In men and women, it was 7.73%, and 14.37%, respectively. The prevalence of abdominal obesity in the population was 21.75%. In men and women, it was 3.2% and 39.2%, respectively.

CONCLUSION

The prevalence of abdominal obesity is high in Nigeria, and needs to be monitored because it is associated with increased cardiovascular risk.

Abdominal body composition measured by quantitative computed tomography and risk of non-spine fractures: the Osteoporotic Fractures in Men (MrOS) Study

The effect of abdominal adiposity and muscle on fracture is unclear in older men; therefore, we examined the association among 749 men aged 65+. Among various adipose tissues and muscle groups, lower psoas muscle volume and higher fatty infiltration of abdominal muscle contribute to higher fracture risk independent of BMD.

INTRODUCTION

The association of abdominal adiposity and muscle composition with incident fracture is unclear, especially in older men. Therefore, we examined the relationship of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), abdominal intermuscular adipose tissue (IMAT), and muscle volume with incident non-spine fractures among 749 men aged 65 and older.

METHODS

A case-cohort study design was used with a total of 252 fracture cases and 497 non-cases. We measured volumes (in centimeters) of adipose and muscle tissues obtained from quantitative computed tomography scan at the L4-5 intervertebral space. Three groups of muscle and IMAT were evaluated: total abdominal, psoas, and paraspinal. Cox proportional hazards regression with a robust variance estimator was used to estimate the hazard ratio (HR) of non-spine fractures per standard deviation (SD) increase in the abdominal body composition measures. The mean age among men in the random subcohort was 74.2 ± 6.1 years, and the average follow-up time was 5.2 ± 1.1 years.

RESULTS

After adjusting for age, race, clinic site, percent body fat, and femoral neck bone mineral density (BMD), no significant relationship was found between incident fractures and SAT or VAT. One SD increase in muscle volume at the psoas, but not paraspinal, was associated with 28 % lower fracture risk (95 % CI = 0.55-0.95). When IMAT models were further adjusted for corresponding muscle volumes, only abdominal IMAT was significantly associated with fracture risk (HR = 1.30 (95 % CI = 1.04-1.63)).

CONCLUSION

Our findings suggest that lower total psoas muscle volume and higher IMAT of the total abdominal muscle contribute to higher fracture risk in older men independent of BMD.

Abdominal fat is associated with lower bone formation and inferior bone quality in healthy premenopausal women: a transiliac bone biopsy study

CONTEXT

The conventional view that obesity is beneficial for bone strength has recently been challenged by studies that link obesity, particularly visceral obesity, to low bone mass and fractures. It is controversial whether effects of obesity on bone are mediated by increased bone resorption or decreased bone formation.

OBJECTIVE

The objective of the study was to evaluate bone microarchitecture and remodeling in healthy premenopausal women of varying weights.

DESIGN

We measured bone density and trunk fat by dual-energy x-ray absorptiometry in 40 women and by computed tomography in a subset. Bone microarchitecture, stiffness, remodeling, and marrow fat were assessed in labeled transiliac bone biopsies.

RESULTS

Body mass index (BMI) ranged from 20.1 to 39.2 kg/m(2). Dual-energy x-ray absorptiometry-trunk fat was directly associated with BMI (r = 0.78, P < .001) and visceral fat by computed tomography (r = 0.79, P < .001). Compared with women in the lowest tertile of trunk fat, those in the highest tertile had inferior bone quality: lower trabecular bone volume (20.4 ± 5.8 vs 29.1 ± 6.1%; P = .001) and stiffness (433 ± 264 vs 782 ± 349 MPa; P = .01) and higher cortical porosity (8.8 ± 3.5 vs 6.3 ± 2.4%; P = .049). Bone formation rate (0.004 ± 0.002 vs 0.011 ± 0.008 mm(2)/mm · year; P = .006) was 64% lower in the highest tertile. Trunk fat was inversely associated with trabecular bone volume (r = -0.50; P < .01) and bone formation rate (r = -0.50; P < .001). The relationship between trunk fat and bone volume remained significant after controlling for age and BMI.

CONCLUSIONS

At the tissue level, premenopausal women with more central adiposity had inferior bone quality and stiffness and markedly lower bone formation. Given the rising levels of obesity, these observations require further investigation.

Association of weight-adjusted body fat and fat distribution with bone mineral density in middle-aged chinese adults: a cross-sectional study

Background

Although it is well established that a higher body weight is protective against osteoporosis, the effects of body fat and fat distribution on bone mineral density (BMD) after adjustment for body weight remains uncertain.

Objective

To examine the relationship between body fat and fat distribution and BMD beyond its weight-bearing effect in middle-aged Chinese adults.

Method

The study had a community-based cross-sectional design and involved 1,767 women and 698 men aged 50–75 years. The BMD of the lumbar spine, total hip, and whole body, and the fat mass (FM) and percentage fat mass (%FM) of the total body and segments of the body were measured by dual-energy X-ray absorptiometry. General information on the participants was collected using structured questionnaire interviews.

Result

After adjusting for potential confounders, an analysis of covariance showed the weight-adjusted (WA-) total FM (or %FM) to be negatively associated with BMD in all of the studied sites (P<0.05) in both women and men. The unfavorable effects of WA-total FM were generally more substantial in men than in women, and the whole body was the most sensitive site related to FM, followed by the total hip and the lumbar spine, in both genders. The mean BMD of the lumbar spine, total hip, and whole body was 3.93%, 3.01%, and 3.65% (in women) and 5.02%, 5.57%, 6.03% (in men) lower in the highest quartile (vs. lowest quartile) according to the WA-total FM (all p<0.05). Similar results were noted among the groups for WA-total FM%. In women, abdominal fat had the most unfavorable association with BMD, whereas in men it was limb fat.

Conclusion

FM (or %FM) is inversely associated with BMD beyond its weight-bearing effect. Abdominal fat in women and limb fat in men seems to have the greatest effect on BMD.

Body mass index compared with abdominal obesity indicators in relation to prehypertension and hypertension in adults: the CHPSNE study

BACKGROUND

Debate ensues regarding the stronger indicator of obesity, body mass index (BMI), or waist circumference (WC), in association with hypertension. Furthermore, little research has been done to compare BMI and WC in their associations with prehypertension.

METHODS

A cross-sectional survey was undertaken in 33 communities randomly selected from 3 cities in Northeastern China during 2009-2010, using a total of 25,196 adults aged 18-74 years with an overall response rate of 87.4%. Diagnoses of prehypertension and hypertension were based on the criteria set by the Seventh Report of the Joint National Committee. Generalized overweight and obesity were defined as BMI 25-29.9 and ≥30 kg/m(2), respectively. Abdominal overweight and obesity were defined as WC 94-102 and >102 cm in men and WC 80-88 and >88 cm in women, respectively.

RESULTS

Both BMI and WC were positively related to the prevalence rate of elevated blood pressure. Among younger individuals, aged 18-44 years, WC seemed to be associated with a higher odds ratio (OR) than BMI for hypertension (e.g., for men, 17.18 (BMI) vs. 23.28 (WC) for obesity), in contrast, BMI seemed to be associated with a higher OR than WC for prehypertension (e.g., for men, 5.99 (BMI) vs. 1.51 (WC) for obesity). Among older individuals, aged ≥45 years, the adjusted OR for hypertension was modestly higher for WC than for BMI in men. In women, the adjusted OR was modestly higher for BMI than for WC.

CONCLUSIONS

In this Chinese population, the association of body fat and abdominal fat with hypertension and prehypertension depends on age and sex.

Relationships between the visceral fat area on CT and coronary risk factor markers

OBJECTIVE

The visceral fat area (VFA) was measured, and the relationships between the VFA and the body mass index (BMI), waist circumference, blood pressure, and indices of lipid and sugar metabolism were evaluated.

METHODS

The subjects included 607 consecutive patients who underwent VFA examinations using computed tomography (CT) scans. In addition to the routine examination parameters, the levels of adiponectin and homeostasis model assessment as an index of insulin resistance (HOMA-IR) were measured in all subjects, and the levels of malondialdehyde-modified low-density lipoprotein (MDA-LDL), remnant-like particles (RLP), lipoprotein (a) (Lp(a)), apolipoprotein (Apo) AI, ApoB and ApoE were measured in 270 subjects.

RESULTS

In both men and women, the VFA showed significant positive correlations with the age, BMI, waist circumference, subcutaneous fat area, visceral fat area/subcutaneous fat area (v/s) ratio, systolic blood pressure, diastolic blood pressure, the fasting blood sugar (FBS), the hemoglobin A1c (HbA1c), high-density lipoprotein cholesterol (HDLC), triglyceride (TG), uric acid, HOMA-IR and ApoB and the ApoB/LDLC ratio and significant negative correlations with the levels of HDLC and adiponectin. The levels of the total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), non-HDLC, MDA-LDL and Lp(a) and the ApoB/ApoAI ratio were not correlated with the VFA in either men or women. The RLP exhibited a significant positive correlation with the VFA in women.

CONCLUSION

The VFA exhibited high positive correlations with the waist circumference, blood pressure and TG level and a negative correlation with the HDLC level, regardless of gender, supporting the validity of the present diagnostic method for evaluating metabolic syndrome (MS). Although the LDLC level is not included in the diagnostic criteria for MS, the positive correlations between the VFA and the ApoB level and ApoB/LDLC ratio observed in both men and women indicate qualitative abnormalities of lipoproteins, such as an increase in the amount of small dense LDL. Measuring the levels of apolipoproteins in addition to lipoproteins during health screening is therefore useful for evaluating of atherogenicity.

Effect of longitudinal changes in visceral fat area and other anthropometric indices to the changes in metabolic risk factors in Japanese men: the Hitachi Health Study

OBJECTIVE

The effects of longitudinal changes in the visceral fat area (VFA), and other anthropometric indices, on the risk factors of metabolic syndrome were not studied. We calculated the changes in metabolic risk factors in relation to changes in certain anthropometric indices in a large-scale study of Japanese men.

RESEARCH DESIGN AND METHODS

The subjects were 1,106 men participating in the Hitachi Health Study who received a computed tomography examination in both 2004 and 2007. VFA, subcutaneous fat area (SFA), and waist circumference were measured using the computed tomography. We examined how longitudinal changes in each anthropometric index over a 3-year period influenced the value of each metabolic risk factor.

RESULTS

Changes (Δ) over a 3-year period in body weight, SFA, and waist circumference strongly correlated, while the changes in body weight and VFA were weakly correlated. Changes in the VFA were associated with changes in metabolic risk factors, especially changes in triglyceride and HDL; we found these changes to be independent of the body weight and waist circumference.

CONCLUSIONS

Change in body weight is not a precise surrogate marker of VFA, and repeated VFA measurements over time are useful. Adopting a lifestyle that does not increase the VFA is important in preventing metabolic syndrome.

The role of bone marrow and visceral fat on bone metabolism

The protective effect of total fat mass on bone mineral density (BMD) has been challenged with studies showing no or negative association after adjusting for weight. Subsequently, more studies have evaluated the relationship of regional adiposity with BMD, and findings were inconsistent for central obesity. Advancements in imaging techniques enable us to directly and noninvasively study the role of adiposity on skeletal health. Visceral adiposity measured by computed tomography (CT) has consistently been shown to have negative effects on bone. Availability of magnetic resonance spectroscopy (MRS) also allows us to noninvasively quantify bone marrow fat (BMF), which has been known to be associated with osteoporosis from histomorphometric studies. Using MRS along with dual energy x-ray absorptiometry, studies have reported a detrimental role of BMF on BMD. With the increase in aging and obesity of the population, it is important to continue this effort in identifying the contribution of adipose tissues to bone quality and fracture.

Single-slice epicardial fat area measurement: do we need to measure the total epicardial fat volume?

PURPOSE

The aim of this study was to assess a method for measuring epicardial fat volume (EFV) by means of a single-slice area measurement. We investigated the relation between a single-slice fat area measurement and total EFV.

METHODS AND METHODS

A series of 72 consecutive patients (ages 65 ± 11 years; 36 men) who had undergone cardiac computed tomography (CT) on a 64-slice multidetector scanner with prospective electrocardiographic triggering were retrospectively reviewed. Pixels in the pericardium with a density range from -230 to -30 Hounsfield units were considered fat, giving the per-slice epicardial fat area (EFA). The EFV was estimated by the summation of EFAs multiplied by the slice thickness. We investigated the relation between total EFV and each EFA.

RESULTS

EFAs measured at several anatomical landmarks-right pulmonary artery, origins of the left main coronary artery, right coronary artery, coronary sinus-all correlated with the EFV (r = 0.77-0.92). The EFA at the LMCA level was highly reproducible and showed an excellent correlation with the EFV (r = 0.92).

CONCLUSION

The EFA is significantly correlated with the EFV. The EFA is a simple, quick method for representing the time-consuming EFV, which has been used as a predictive indicator of cardiovascular diseases.

Low density lipoprotein cholesterol is inversely correlated with abdominal visceral fat area: a magnetic resonance imaging study

Background

Visceral Fat Area (VFA) is an independent predictor of coronary disease. While low density lipoprotein cholesterol (LDL-C) is used to determine risk and guide therapy, its accuracy fails in obese patients who may have low LDL-C despite high VFA.

Objective

We sought to describe the relationship between VFA, LDL-C and to describe shifting cholesterol metabolism with increasing VFA.

Methods

42 High-risk vascular patients not on lipid-lowering therapy provided a fasting lipid profile and underwent magnetic resonance imaging (MRI) to quantify VFA and subcutaneous fat area (SFA) at the L4-L5 disc. Comparisons: 1. Correlation between VFA, SFA, LDL-C and the standard lipid panel 2. Correlation between VFA, SFA and markers of cholesterol synthesis (desmosterol, lathosterol) and cholesterol absorption (cholestanol, sitosterol).

Results

VFA was inversely correlated with LDL-C (r = -0.348) indicating potential discordance between cardiovascular risk and LDL-C. However, VFA was appropriately correlated with other markers of increased risk: r = -0.361 with HDL-C, r = 0.503 with VLDL-C, r = 0.499 with TG (all p < 0.05). VFA did not correlate significantly with non-HDL-C. VFA correlated positively with cholesterol synthesis markers (desmosterol, lathosterol) and negatively with an absorption marker (cholestanol).

Conclusions

LDL-C is inversely correlated with VFA and this may explain the loss of the relationship between LDL-C and cardiovascular events in the obese. While Non-HDL-C did not correlate positively with VFA, the absence of a negative correlation suggests that it may be a more appropriate lipid target in an increasingly obese world.

Pericardial fat is more abundant in patients with coronary atherosclerosis and even in the non-obese patients: evaluation with cardiac CT angiography

Epicardial adipose tissue (EAT) may play an important role for developing an unfavorable cardiovascular risk profile. However, it has not been investigated if EAT is associated with coronary atherosclerosis in non-obese patients. We aimed to evaluate whether EAT is related to coronary atherosclerosis in non-obese patients. Among the consecutive patients who underwent coronary CT angiography(CCTA) with an intermediate pretest likelihood for having coronary artery disease, we excluded the patients whose body mass index (BMI) was over 30 kg/m(2) or whose CCTA image quality was not sufficient for the detection of coronary plaque. The remaining patients were divided into the normal and abnormal groups based on the presence of atherosclerotic plaques as seen on the CCTA images. The cardiovascular risk factors were matched between the two groups. Ultimately, 100 patients were included in the normal group and 100 patients were included in the abnormal group. The pericardial fat area was measured at the subaortic level of the heart on the axial CT images. The pericardial fat area was significantly larger in the abnormal group as compared to the normal group (18.1 +/- 10.2 vs. 14.6 +/- 8.7 cm(2),P = 0.019). Even though the overweight patients(25 </= BMI < 30) were excluded, the pericardial fat area was still significantly larger in the patients with coronary atherosclerotic plaque as compared to that of the patients without coronary atherosclerotic plaque (18.7 +/- 11.5 vs. 13.2 +/- 7.9 cm(2), P = 0.006). Pericardial fat was more abundant in the non-obese patients with coronary atherosclerosis as compared to that of the patients without coronary atherosclerosis,after controlling for the other cardiovascular risk factors.

Sonographically measured perirenal fat thickness: an early predictor of atherosclerosis in HIV-1-infected patients receiving highly active antiretroviral therapy?

PURPOSE

The aim of our study was to evaluate whether perirenal fat thickness (PRFT), a parameter of central obesity, is related to carotid intima-media thickness (IMT), an index of atherosclerosis in human immunodeficiency virus (HIV)-1-infected patients.

METHODS

We enrolled 70 consecutive HIV-1-infected patients receiving highly active antiretroviral therapy for more than 12 months, in a prospective cohort study. Sonographically measured PRFT and carotid IMT, as well as serum metabolic parameters, were evaluated. PRFT and IMT were measured using 3.75-MHz convex and 7.5-MHz linear probes, respectively.

RESULTS

The mean PRFT and IMT in HIV-1-infected patients with visceral obesity was significantly greater than those in patients without it (p < 0.0001 and p < 0.01, respectively). Using the average IMT as the dependent variable in regression analysis, PRFT was an independent factor associated with carotid IMT (p < 0.05). A PRFT of 6.4 mm was the most discriminatory value for predicting an IMT >or= 0.9 mm (sensitivity 83.3%, specificity 83.9%). Subjects with visceral obesity had a progressively increasing carotid IMT on the 12-month measurement (p < 0.05).

CONCLUSION

Our data demonstrated that PRFT measurement could be used as an early predictor of IMT increase in HIV-1-infected patients receiving highly active antiretroviral therapy.

Reciprocal relations of subcutaneous and visceral fat to bone structure and strength

CONTEXT

Increased body fat is a risk factor for cardiovascular and metabolic disease, yet it is uncertain whether obesity protects against osteoporosis or adiposity is harmful to bone.

OBJECTIVE

The aim of the study was to assess whether the pattern of adipose tissue deposition influences bone structure and strength.

DESIGN

The relations between sc and visceral adiposity and the cross-sectional dimensions and polar and principal moments of the femur in 100 healthy women ages 15 to 25 years were obtained using computed tomography.

RESULTS

Multiple linear regression analyses indicated that, after adjusting for leg length and thigh musculature, both sc and visceral fat had strong and independent associations with femoral cross-sectional area, cortical bone area, principal moment maximum, principal moment minimum, and polar moment (all P values < 0.03). However, whereas sc fat had a positive predictive value with all femoral bone phenotypes, a similar but negative effect was observed between visceral fat and these measures (all P values < 0.01).

CONCLUSIONS

We found that visceral and sc fat have opposite effects on the appendicular skeleton; whereas sc fat is beneficial to bone structure and strength, visceral fat serves as an unique pathogenic fat depot.

Obesity markers and estimated 10-year fatal cardiovascular risk in Switzerland

BACKGROUND AND AIM

There is an ongoing debate on which obesity marker better predicts cardiovascular disease (CVD). In this study, the relationships between obesity markers and high (>5%) 10-year risk of fatal CVD were assessed.

METHODS AND RESULTS

A cross-sectional study was conducted including 3047 women and 2689 men aged 35-75 years. Body fat percentage was assessed by tetrapolar bioimpedance. CVD risk was assessed using the SCORE risk function and gender- and age-specific cut points for body fat were derived. The diagnostic accuracy of each obesity marker was evaluated through receiver operating characteristics (ROC) analysis. In men, body fat presented a higher correlation (r=0.31) with 10-year CVD risk than waist/hip ratio (WHR, r=0.22), waist (r=0.22) or BMI (r=0.19); the corresponding values in women were 0.18, 0.15, 0.11 and 0.05, respectively (all p<0.05). In both genders, body fat showed the highest area under the ROC curve (AUC): in men, the AUC (95% confidence interval) were 76.0 (73.8-78.2), 67.3 (64.6-69.9), 65.8 (63.1-68.5) and 60.6 (57.9-63.5) for body fat, WHR, waist and BMI, respectively. In women, the corresponding values were 72.3 (69.2-75.3), 66.6 (63.1-70.2), 64.1 (60.6-67.6) and 58.8 (55.2-62.4). The use of the body fat percentage criterion enabled the capture of three times more subjects with high CVD risk than the BMI criterion, and almost twice as much as the WHR criterion.

CONCLUSION

Obesity defined by body fat percentage is more related with 10-year risk of fatal CVD than obesity markers based on WHR, waist or BMI.

[Survey of relationship between measurement of abdominal circumference and metabolic syndrome on new health check in university]

In April 2008, a system of special health checks and health guidance was initiated with the aim of identifying people with metabolic syndrome (visceral fat syndrome) and pre-metabolic syndrome. In this study, we investigated the relationship between health check results and abdominal circumference in 632 university faculty members. The standard value for abdominal circumference in women (> or =90) is set higher than that for men (> or =85). When this standard value is used, only 7.4% of women may be able to receive special health guidance. In the future, a follow-up survey of female subjects focusing on the difference in the standard value and an evaluation of its relationship with lifestyle-related diseases will probably be necessary. In the present study, significant positive correlations were seen between abdominal circumference and GPT and gamma-GTP, which are related to hepatic function, and between abdominal circumference and uric acid levels in males. These results indicate the possibility that abdominal circumference is related to alcohol intake. In addition, white blood cell count, red blood cell count, hemoglobin level, and hematocrit level were significantly higher in subjects with large abdominal circumference, and there were differences in hematopoietic function. There have been virtually no studies on the relationship between visceral fat and hepatic and hematopoietic functions, and a follow-up study of the present subjects in the future may shed new light on risk factors for various diseases with abdominal circumference as an indicator.

Prevalence of obesity and abdominal obesity in the Lausanne population

BACKGROUND

Obesity can be defined using body mass index (BMI) or waist (abdominal obesity). Little information exists regarding its prevalence and determinants in Switzerland. Hence, we assessed the levels of obesity as defined by BMI or waist circumference in a Swiss population-based sample.

METHODS

Cross-sectional, population-based non-stratified random sample of 3,249 women and 2,937 men aged 35-75 years living in Lausanne, Switzerland. Overall participation rate was 41%.

RESULTS

In men, the prevalences of overweight (BMI > or =25 kg/m2) and obesity (BMI > or =30 kg/m2) were 45.5% and 16.9%, respectively, higher than in women (28.3% and 14.3%, respectively). The prevalence of abdominal obesity (waist > or =102 in men and > or =88 cm in women) was higher in women than in men (30.6% vs. 23.9%). Obesity and abdominal obesity increased with age and decreased with higher educational level in both genders. In women, the prevalence of obesity was lower among former and current smokers, whereas in men the prevalence of obesity was higher in former smokers but did not differ between current and never smokers. Multivariate analysis showed age to be positively related, and education and physical activity to be negatively related with obesity and abdominal obesity in both genders, whereas differential effects of smoking were found between genders.

CONCLUSION

The prevalence of abdominal obesity is higher than BMI-derived obesity in the Swiss population. Women presented with more abdominal obesity than men. The association between smoking and obesity levels appears to differ between genders.

Waist circumference correlates with hepatic fat accumulation in male Japanese patients with non-alcoholic fatty liver disease, but not in females

BACKGROUND AND AIM

Abdominal obesity, a component of metabolic syndrome, is a major risk factor for non-alcoholic fatty liver disease (NAFLD). In recent worldwide definitions of metabolic syndrome, waist measurement has been proposed as a simple and useful estimate of abdominal obesity, taking into account gender differences in waist circumference. The present cross-sectional study investigated the correlation of hepatic fat accumulation and waist circumference in Japanese NAFLD patients to determine if there are gender differences in this relationship.

METHODS

Consecutive patients (n = 2111) who had at least one of two criteria for liver disease (alanine aminotransferase [ALT] level >30 IU/mL and aspartate aminotransferase [AST]/ALT ratio <1) underwent abdominal ultrasonography. Patients positive for hepatitis B virus, hepatitis C virus or autoimmune antibodies and whose alcohol intake was >20 g/day were excluded. Patients with NAFLD underwent abdominal computed tomography. Hepatic fat accumulation was estimated by liver/spleen attenuation ratio (L/S ratio) and visceral adipose accumulation was measured as visceral fat area (VFA) at the umbilical level.

RESULTS

Of the 221 NAFLD patients, 103 were females. In males, the relationship between L/S ratio and waist circumference was negative (r =-0.356, P < 0.01), and there was no correlation in the female group. The relationship between L/S ratio and VFA was negative in both groups (males: r = -0.269, P < 0.01; females: r = -0.319, P < 0.01). Subcutaneous fat area/total fat area ratio at the umbilical level was larger in females than in males (P < 0.01).

CONCLUSIONS

In NAFLD patients, waist measurement is more susceptible to gender differences than VFA.

Association of obesity and visceral fat distribution with intima-media thickness of carotid arteries in middle-aged and older persons

OBJECTIVE

The association between obesity and atherosclerotic disease is controversial. We examined whether common carotid intima-media thickness (IMT), a precursor to preclinical atherosclerosis, was associated with total body fatness or the accumulation of fat mass in the abdominal region in middle-aged and older persons.

METHODS

Participants were consecutively enrolled from patients aged >or=50 years, and were 623 men aged 73+/-10 (mean+/-standard deviation) years and 835 women aged 76+/-10 years. Demographic data were collected and maximal preperitoneal fat thickness (PFT(max)) and carotid intima-media thickness (IMT) were evaluated on B-mode ultrasonography. Subjects were divided into 3 groups on the basis of body mass index (BMI), a marker of general obesity.

RESULTS

It was shown by multiple regression analysis for IMT that age, smoking status, hypertension and uric acid were significantly associated with IMT in subjects in the lowest BMI group (<20 kg/m(2)), and age, hypertension, dyslipidemia and uric acid in middle BMI group (20-22.9 kg/m(2)). Moreover, man sex, age, BMI, PFT(max), smoking status, hypertension and uric acid were significantly associated with IMT in subjects with highest BMI group (>or=23 kg/m(2)). Analysis of covariance showed that interaction between BMI and visceral obesity (f=7.202, p=0.007) was significantly associated with IMT, in addition to age, visceral obesity, smoking status, hypertension, dyslipidemia and uric acid.

CONCLUSION

The present study indicates a graded and independent association between general and visceral obesity and preclinical carotid artery changes in patients aged >or=50 years with a BMI >or=23 kg/m(2).

Tomografia computadorizada na avaliação da distribuição do tecido adiposo abdominal de ratos alimentados com rações hiperlipídicas após desnutrição neonatal

OBJETIVO: Descrever repercussões da ração suplementada com óleo de soja ou óleo de canola, por meio da tomografia computadorizada, na distribuição do tecido adiposo abdominal, após desmame de ratos desnutridos durante a lactação. MATERIAIS E MÉTODOS: Ratas lactantes submetidas a restrição alimentar (RA) em 50%, de acordo com o consumo das lactantes controles (C). Após o desmame, filhotes desnutridos receberam ração contendo 19% de óleo de soja (RA-soja 19%) ou óleo de canola (RA-canola 19%). Os filhotes do grupo controle receberam ração contendo 7% de óleo de soja (C-soja 7%). Aos 60 dias de idade, foram realizadas medidas corporais e das áreas de tecido adiposo abdominal por meio de tomografia computadorizada. Após sacrifício, tecido adiposo abdominal foi excisado e pesado. Os dados foram expressos como média ± erro-padrão da média, considerando o nível de significância de p < 0,05. RESULTADOS: Os grupos RA 19% desenvolveram similares comprimento, massa corporal e depósito de tecido adiposo visceral. Todas as avaliações realizadas foram significantemente menores em relação ao grupo C-soja 7%. Entretanto, na tomografia computadorizada, os grupos RA-soja 19% e RA-canola 19% apresentaram diferenças significativas da distribuição do tecido adiposo abdominal. CONCLUSÃO: A tomografia computadorizada mostrou que a distribuição de tecido adiposo, na cavidade abdominal, pode ser dependente do tipo de óleo vegetal na dieta.

Intermuscular adipose tissue rivals visceral adipose tissue in independent associations with cardiovascular risk

BACKGROUND

The metabolic implications of intermuscular adipose tissue (IMAT) are poorly understood compared to those of visceral adipose tissue (VAT) even though the absolute quantities of both depots are similar in many individuals.

OBJECTIVE

The aim was to determine the independent relationship between whole-body IMAT and cardiovascular risk factor parameters.

DESIGN

Whole body magnetic resonance imaging (MRI) was used to quantify total skeletal muscle (SM), total adipose tissue (TAT) of which IMAT, defined as the AT visible by MRI within the boundary of the muscle fascia, is a sub-component. Fasting serum measures (n=262) of glucose, total cholesterol (T-Chol), high-density lipoprotein cholesterol (HDL-Chol), triglycerides (TG), protein bound glucose (PBG, n=206) and insulin (n=119) were acquired in healthy African-American (AA, n=78) and Caucasian (Ca, n=109) women (body mass index (BMI) 26.5+/-5.7 kg/m(2); 44.4+/-16.4 years) and men (39 AA, 62 Ca; BMI 25.6+/-3.5 kg/m(2); 45.6+/-17.4 years). General linear models identified the independent effects of IMAT after covarying for SM, VAT, TAT, race, sex and two-way interactions.

RESULTS

Significant independent associations were observed for IMAT with glucose (P<0.001), PBG (P<0.001) and T-Chol (P<0.05). The association of IMAT with cholesterol differed by race in such a manner that for a unit increase in IMAT, T-Chol increased more rapidly in Ca compared to AA (P<0.05). TG, HDL-Chol and insulin had no independent association with IMAT.

CONCLUSION

The strong independent associations of IMAT with fasting glucose and PBG suggest that IMAT may be related to glucose metabolism; however, IMAT is also associated with T-Chol in Ca.

Serum butyrylcholinesterase is strongly associated with adiposity, the serum lipid profile and insulin resistance

OBJECTIVE

We investigated the association between the serum butyrylcholinesterase (BChE) activity and parameters of adiposity, insulin resistance and the serum lipid profile, including the serum levels of triglyceride (TG), HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C) in Japanese patients with type 2 diabetes and non-diabetic subjects.

PATIENTS AND METHODS

A total of 259 Japanese subjects [171 patients with type 2 diabetes (age 60.4+/-11.9 years, BMI 25.0+/-4.4) and 88 non-diabetic subjects (age 54.2+/-15.0 years, BMI 25.8+/-4.7)] were enrolled in the study. To assess the hepatic fat content, the ratio of the CT attenuation value of the liver to that of the spleen (L/S ratio) was calculated.

RESULTS

Serum BChE activity was significantly correlated with various indices of adiposity, including the waist circumference, L/S ratio, visceral fat area (VFA), subcutaneous fat area (SFA) and BMI, and also with the TG, HDL-C, LDL-C and HOMA-R, in the entire subject population. Even after adjustment for five variables, namely, age, gender, HbA1c, CRP and serum ferritin (the serum levels of ferritin and CRP have been reported to be associated with adiposity and insulin resistance), the serum BChE activity was still correlated with the waist circumference, L/S ratio, VFA, SFA, BMI, TG, HDL-C, LDL-C and HOMA-R. Furthermore, changes in the serum BChE activity were associated with changes in the L/S ratio, VFA and SFA at 1 year after the baseline.

CONCLUSIONS

These results indicate that the serum BChE activity is associated with parameters of adiposity, the serum lipid profile and the degree of insulin resistance.

Heart Rate Variability in Adolescents: Relations to Physical Activity, Fitness, and Adiposity

PURPOSE

We determined the degree to which variation in cardiac autonomic modulation was explained by race, sex, moderate-vigorous physical activity (MVPA), cardiovascular fitness (CVF), percent body fat (%BF), waist girth, subcutaneous abdominal adipose tissue (SAAT), and visceral adipose tissue (VAT).

METHODS

Subjects were 304 adolescents; SAAT and VAT values were available for 168 youths. Cardiac parasympathetic modulation (PM) was the root mean square of successive differences (RMSSD). Sympathetic-parasympathetic balance was the ratio of low- to high-frequency power (LFnu:HFnu). MVPA was measured with accelerometry, CVF with a treadmill, %BF with dual-energy x-ray absorptiometry (DXA), and SAAT and VAT with magnetic resonance imaging (MRI).

RESULTS

Root mean square of successive differences was higher, and LFnu:HFnu was lower, in blacks than in whites. The final regression model revealed positive relations with CVF and MVPA, and a %BF by race by sex interaction, such that higher %BF was associated with lower RMSSD in black females and higher RMSSD in white females. Higher RMSSD was associated with lower VAT; for SAAT, the relationship was negative for blacks and positive for whites. For LFnu:Hfnu, a negative relationship was seen with MVPA and higher waist girth was associated with a higher ratio in blacks, but not in whites. Both higher VAT and SAAT were related to higher LFnu:HFnu.

CONCLUSIONS

Black youths had a more favorable HRV profile than white youths. After controlling for age, race, and sex, more favorable HRV profiles were associated with more MVPA, better CVF, and less visceral and subcutaneous adiposity. The deleterious impact of higher adiposity was greater in blacks, especially females, than in whites. Enhancement of cardiac autonomic modulation may be a pathway through which physical activity, fitness, and leanness contribute to cardiovascular health early in life.